<%@ page contentType="text/html;charset=UTF-8" %>
<%@ include file="/WEB-INF/views/include/taglib.jsp"%>
<ul class="nav nav-tabs">
  <li class="active">
    <a href="#">执行单</a>
  </li>
</ul>
<div class="row" id="topDivId">
  <div class="col-lg-12">
    <section class="panel">
      <div class="panel-body">
        <form class="form-horizontal" id="patientInfo">
          <div class="col-lg-3">
            <div class="form-group">
              <label class="col-sm-3 control-label">床标号：</label>
              <div class="col-sm-5">
                <input name="bedLabel" id="clinicName" value="${patVisit.bedRec.bedNo}" class="form-control"  maxlength="50"  />
              </div>
            </div>
            <div class="form-group">
              <label class="col-sm-3 control-label">预交金：</label>
              <div class="col-sm-5">
                <input name="name" id="payment" value="${patVisit.prepayments}"  class="form-control"  maxlength="50" />
              </div>
            </div>
          </div>
          <div class="col-lg-3">
            <div class="form-group">
              <label class="col-sm-3 control-label">姓名：</label>
              <div class="col-sm-5">
                <input name="name"  id="name" value="${patVisit.patVisitIndex.name}" class="form-control"  maxlength="50"  />
              </div>
            </div>
            <div class="form-group">
              <label class="col-sm-3 control-label">费别：</label>
              <div class="col-sm-5">
                <input name="chargeType" id="chargeType" value="${fns:getDictLabels(patVisit.patVisitIndex.chargeType, 'CHARGE_TYPE_DICT', '')}" class="form-control"  maxlength="50" />
              </div>
            </div>
          </div>
          <div class="col-lg-3">
            <div class="form-group">
              <label class="col-sm-3 control-label">性别：</label>
              <div class="col-sm-5">
                <input name="sex"  id="sex" value="${fns:getDictLabels(patVisit.patVisitIndex.sex, 'SEX_DICT', '')}" class="form-control"  maxlength="50"  />
              </div>
            </div>
            <div class="form-group">
              <label class="col-sm-3 control-label">诊断：</label>
              <div class="col-sm-5">
                <input name="diagnosis" id="diagnosis" value="${patVisit.diagnosis}"  class="form-control"  maxlength="50" />
              </div>
            </div>
          </div>
          <div class="col-lg-3">
            <div class="form-group">
              <label class="col-sm-3 control-label">年龄：</label>
              <div class="col-sm-5">
                <input name="age"  id="age" class="form-control" value="${patVisit.patVisitIndex.age}"  maxlength="50"  />
              </div>
            </div>
            <div class="form-group">
              <label class="col-sm-3 control-label">经治医师：</label>
              <div class="col-sm-5">
                <input name="doctorInCharge" id="doctor" value="${patVisit.doctorInCharge}"  class="form-control"  maxlength="50" />
              </div>
            </div>
          </div>
        </form>
      </div>
    </section>
  </div>
</div>